POS1317 HOW CAN WE ASSESS CARDIOVASCULAR RISK IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS? PRELIMINARY RESULTS REGARDING MEASUREMENTS OF CAROTID INTIMA-MEDIA THICKNESS DURING THE COVID-19 PANDEMIC.
Authors: M. Gruca, K. Orczyk, J. Zamojska, K. Niewiadomska-Jarosik, J. Stanczyk, E. Smolewska
Journal: Annals of the Rheumatic Diseases (2022)

Background There is growing body of evidence that adults who were diagnosed as children with juvenile idiopathic arthritis (JIA) have significantly increased risk of developing cardiovascular disease. Risk factors including prolonged sedentary screen time, insufficient physical activity and unhealthy diet are even more essential in the era of the COVID-19 pandemic. However, there is lack of simple and reliable prognostic marker identifying children at higher risk of early development of cardiovascular disease. Non-invasive tests utilized in adults to screen for early phase of atherosclerosis involve examination of the carotid intima-media thickness (cIMT). Only a few research projects have evaluated performance of cIMT measurement in JIA patients and the results remain inconclusive. Objectives The aim of this study was to evaluate the usefulness of cIMT testing as a screening method to determine cardiovascular risk in JIA patients. The secondary objective was to assess the frequency of risk factors related to the patients’ lifestyle during the COVID-19 pandemic. Methods The study involved forty-five patients at mean age 13.4±3.2 years who were already diagnosed with JIA and thirty-seven age- and sex-matched healthy controls. Children were enrolled in the study between March 2020 and September 2021. Study database included demographic data, conventional risk factors for developing cardiovascular disease (e.g. abnormal body mass index and exposure to secondhand smoking), inflammatory markers and disease activity score. Measurements of cIMT were performed by a qualified physician according to the standardized protocol using high resolution ultrasonography. Results Measurement of cIMT revealed values above 94 th percentile in four children (three males and one female) who were all diagnosed with JIA. The quantity of abnormal results was not enough to verify the hypothesis of increased cardiovascular risk in JIA patients, though (p=0.06296). However, children diagnosed with JIA are more likely to have abnormal body mass index than their healthy peers (51.1% vs. 21.6%, p=0.00614). Children who doubled their sedentary screen time during the COVID-19 pandemic skipped the sufficient physical activity (p=0.03352). Correlation between elevated ESR and higher cIMT values in right carotid artery was marginally significant (r=0.292, p=0.051443). Regardless of JIA, exposure to secondhand smoking was proved as a significant risk factor of atherosclerosis (18.2% vs. 2.8%, p=0.02771). Conclusion Screening measurements of cIMT should be considered in the follow-up of JIA patients with higher disease activity with concurrent elevated ESR. Defining other indications for performing such examination requires further investigation involving larger study group. Healthy lifestyle, including reducing secondhand smoke exposure, needs to be promoted with utmost importance during the COVID-19 pandemic, especially in children with chronic diseases like JIA. References [1]Del Giudice E, Dilillo A, Tromba L et al. Aortic, carotid intima-media thickness and flow- mediated dilation as markers of early atherosclerosis in a cohort of pediatric patients with rheumatic diseases. Clin Rheumatol. 2018 Jun;37(6):1675-1682. doi: 10.1007/s10067-017-3705-7. [2]Hussain KS, Gulati R, Satheesh S et al. Early-onset subclinical cardiovascular damage assessed by non-invasive methods in children with Juvenile Idiopathic Arthritis: analytical cross-sectional study. Rheumatol Int. 2021 Feb;41(2):423-429. doi: 10.1007/s00296-020-04689-z. Disclosure of Interests None declared